超高齢者（85歳以上）における血管内血栓回収療法：高治療施設からの転帰に関する報告

Endovascular therapy (EVT) has become the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, the impact of advanced age on EVT outcomes remains unclear. This study evaluated the safety, efficacy, and outcomes of EVT in elderly patients (≥85 years) compared to younger individuals in a real-world cohort.

We conducted a retrospective analysis of the Stroke Research Consortium in Northern Bavaria (STAMINA) database, identifying 581 patients with occlusion in the anterior circulation who underwent EVT. Patients were stratified by age (≥85 years: n=95; <85 years: n=486). The primary outcome was functional recovery at 90 days, defined as a modified Rankin Scale (mRS) score ≤ pre-stroke mRS or pre-stroke mRS +1. Secondary outcomes included good functional outcome (mRS ≤2), mortality, successful EVT (TICI ≥ 2b), and symptomatic intracerebral hemorrhage (sICH).

Elderly patients had a significantly higher 90-day mortality rate (53.8% vs 22.3%, p<0.001) and lower rates of good functional outcomes (1.1% vs. 27.0%, p<0.001). Functional recovery occurred in 13.7% of elderly patients compared to 21.0% in younger patients (p=0.14). Rates of sICH were similar (12.6% vs. 8.8%, p=0.34). Pre-stroke mRS was a significant predictor of good outcome in the elderly, with each one-point increase associated with a 56% decrease in the odds of achieving independence (OR 0.43, 95% CI 0.32-0.61; p<0.001).

EVT is technically feasible in elderly patients but associated with worse outcomes and higher mortality. Age alone should not exclude patients from EVT, though careful consideration of pre-stroke status is essential for individualized decision-making.